Hypokalemia differential diagnosis: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
Ahmed Younes (talk | contribs) No edit summary |
||
(15 intermediate revisions by 5 users not shown) | |||
Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hypokalemia]] | |||
{{CMG}}; {{AE}}{{EG}} | {{CMG}}; {{AE}}{{EG}} | ||
== Overview == | == Overview == | ||
[[Potassium]] is one of the [[intracellular]] [[cation]]. Any derangement of potassium serum levels can disturb the transmembrane [[potential]] and renders excitable cells ([[nerve]] and [[muscle]]) [[Hyperpolarization (biology)|hyperpolariz]]<nowiki/>ed and less excitable. However, [[Cardiac|cardiac cells]] don't obey this rule and become hyperexcitable. [[Potassium]] regulation is essential to maintain a normal activity in cells. Any imparment in potassium serum levels will have severe consequences on several organs especially the [[heart]] and the [[nervous system]]. | |||
== Differentiating Causes of Hypokalemia == | == Differentiating Causes of Hypokalemia == | ||
=== Differentiating the diseases that can cause hypokalemia is as following table: === | === Differentiating the diseases that can cause hypokalemia is as following table: === | ||
{| | <small><small> | ||
{| class="wikitable" | |||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
! colspan="2" rowspan="5" |Diseases | ! colspan="2" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases | ||
! colspan="8" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations''' | ! colspan="8" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations''' | ||
! colspan=" | ! colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para−clinical findings | ||
! colspan="1" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard''' | ! colspan="1" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard''' | ||
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings | ! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings | ||
Line 19: | Line 20: | ||
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination | ! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination | ||
|- | |- | ||
! colspan=" | ! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings | ||
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging | ! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging | ||
|- | |- | ||
Line 30: | Line 31: | ||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |ABG | ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |ABG | ||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinalysis | ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinalysis | ||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Transtubular potassium gradient | |||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urine Potassium:Creatinine | |||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other | ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other | ||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasonography | ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasonography | ||
Line 38: | Line 41: | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nocturia | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nocturia | ||
|- | |- | ||
! rowspan="7" |[[Renal]] and [[adrenal disorders]] | ! rowspan="7" style="background: #DCDCDC; text-align: center;" |[[Renal]] and [[adrenal disorders]] | ||
![[ | ! style="background: #DCDCDC; text-align: center;" |[[Loop diuretics|Loop diuretic use]]<ref name="pmid8199766">{{cite journal |vauthors=Bourke E, Delaney V |title=Prevention of hypokalemia caused by diuretics |journal=Heart Dis Stroke |volume=3 |issue=2 |pages=63–7 |date=1994 |pmid=8199766 |doi= |url=}}</ref> | ||
!+ | ! +/− | ||
! | !− | ||
!+ | ! + | ||
! | !− | ||
!+/ | ! +/− | ||
! | !↓ | ||
! | !− | ||
! | ! + | ||
![[Metabolic alkalosis]] | ![[Metabolic alkalosis]] | ||
!↑[[Potassium|K]] | !↑[[Potassium|K<sup>+</sup>]] | ||
! | ! rowspan="7" |> 7 | ||
! rowspan="7" |>20mEq/g | |||
! | !↑'''[[Sodium|Na<sup>+</sup>]]''' | ||
! | !− | ||
! | !− | ||
!History of medication use | |||
!− | |||
|- | |- | ||
![[ | ! style="background: #DCDCDC; text-align: center;" |[[Primary hyperaldosteronism]]<ref name="pmid28101185">{{cite journal| author=Wu C, Xin J, Xin M, Zou H, Jing L, Zhu C et al.| title=Hypokalemic myopathy in primary aldosteronism: A case report. | journal=Exp Ther Med | year= 2016 | volume= 12 | issue= 6 | pages= 4064-4066 | pmid=28101185 | doi=10.3892/etm.2016.3864 | pmc=5228118 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28101185 }}</ref> | ||
!+ | ! + | ||
! | !− | ||
!+ | ! + | ||
! | !− | ||
!+ | ! + | ||
! | !↑ | ||
! | ![[Facial flushing]] | ||
! | !− | ||
![[Metabolic alkalosis]] | ![[Metabolic alkalosis]] | ||
!↑[[Potassium|K]], ↓[[ | !↑[[Potassium|K<sup>+</sup>]], ↓'''[[Sodium|Na<sup>+</sup>]]''' | ||
! | !↓'''[[Plasma renin activity|PRA]]''', ↑'''[[Aldosterone|PAC]], ↓[[Sodium|Na<sup>+</sup>]]''' | ||
! | !Unilateral [[adrenal hyperplasia]] | ||
! | !Hypodense unilateral [[Adrenal Mass|adrenal macroadenoma]] (>1 cm) | ||
!'''[[Aldosterone|PAC]]:[[Plasma renin activity|PRA]] ratio''' | |||
![[ | ![[Mood disturbances|Mood disturbance]], [[Paresthesias|paresthesia]], [[muscle cramps]] | ||
|- | |- | ||
![[ | ! style="background: #DCDCDC; text-align: center;" |[[Cushing syndrome]]<ref name="pmid12381548">{{cite journal |vauthors=Torpy DJ, Mullen N, Ilias I, Nieman LK |title=Association of hypertension and hypokalemia with Cushing's syndrome caused by ectopic ACTH secretion: a series of 58 cases |journal=Ann. N. Y. Acad. Sci. |volume=970 |issue= |pages=134–44 |date=September 2002 |pmid=12381548 |doi= |url=}}</ref> | ||
! | ! + | ||
! | ! +/− | ||
!+/ | ! +/− | ||
! | !− | ||
! | !− | ||
!↑ | !↑ | ||
! | ![[Plethora|Facial plethora]], [[Striae|purple striae]] | ||
!+ | ! + | ||
![[Metabolic alkalosis]] | ![[Metabolic alkalosis]] | ||
! | ![[Glucosuria]] | ||
! | !↑[[Blood sugar|BS]] | ||
! | !Unilateral [[adrenal hyperplasia]] | ||
!− | |||
!'''Urinary free [[cortisol]] (24−hour)''' | |||
!Dorsicocervical [[fat pad]], [[obesity]], [[hirsutism]] | |||
|- | |- | ||
![[Hemodialysis]]<ref name="pmid23946760">{{cite journal| author=Choi HY, Ha SK| title=Potassium balances in maintenance hemodialysis. | journal=Electrolyte Blood Press | year= 2013 | volume= 11 | issue= 1 | pages= 9-16 | pmid=23946760 | doi=10.5049/EBP.2013.11.1.9 | pmc=3741441 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23946760 }}</ref> | ! style="background: #DCDCDC; text-align: center;" |[[Hemodialysis]]<ref name="pmid23946760">{{cite journal| author=Choi HY, Ha SK| title=Potassium balances in maintenance hemodialysis. | journal=Electrolyte Blood Press | year= 2013 | volume= 11 | issue= 1 | pages= 9-16 | pmid=23946760 | doi=10.5049/EBP.2013.11.1.9 | pmc=3741441 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23946760 }}</ref> | ||
!+/ | ! +/− | ||
!+/ | ! +/− | ||
!+/ | ! +/− | ||
! | !− | ||
! | !− | ||
!Normal | !Normal | ||
![[Pustular rash|Pustular lesions]] | ![[Pustular rash|Pustular lesions]] | ||
! | !− | ||
![[Metabolic alkalosis]] | ![[Metabolic alkalosis]] | ||
!Normal | !Normal | ||
!↓[[Sodium|Na]] | !↓'''[[Sodium|Na<sup>+</sup>]]''' | ||
! | !− | ||
! | !− | ||
!History | !History | ||
![[Carpal tunnel syndrome]] | ![[Carpal tunnel syndrome]] | ||
|- | |- | ||
![[ | ! style="background: #DCDCDC; text-align: center;" |[[Bartter syndrome]]<ref name="pmid12920401">{{cite journal |vauthors=Hebert SC |title=Bartter syndrome |journal=Curr. Opin. Nephrol. Hypertens. |volume=12 |issue=5 |pages=527–32 |date=September 2003 |pmid=12920401 |doi=10.1097/01.mnh.0000088732.87142.43 |url=}}</ref> | ||
!+ | ! + | ||
! | !− | ||
!+ | ! + | ||
! | !− | ||
!+ | ! +/− | ||
! | !Normal or ↓ | ||
! | !− | ||
! | !− | ||
![[Metabolic alkalosis]] | |||
!↑[[Potassium|K<sup>+</sup>]], ↑[[Ca|Ca<sup>+2</sup>]], ↑[[Chloride|Cl<sup>-</sup>]] | |||
!− | |||
!− | |||
!− | |||
![[Bartter syndrome laboratory findings|Laboratory findings]] | |||
![[Mental retardation]], [[sensorineural hearing loss]] | |||
|- | |||
! style="background: #DCDCDC; text-align: center;" |[[Gitelman syndrome]]<ref name="pmid18667063">{{cite journal| author=Knoers NV, Levtchenko EN| title=Gitelman syndrome. | journal=Orphanet J Rare Dis | year= 2008 | volume= 3 | issue= | pages= 22 | pmid=18667063 | doi=10.1186/1750-1172-3-22 | pmc=2518128 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18667063 }}</ref> | |||
! + | |||
!− | |||
! + | |||
!− | |||
! + | |||
!Normal | |||
!− | |||
!− | |||
![[Metabolic alkalosis]] | ![[Metabolic alkalosis]] | ||
!↑[[Potassium|K]], ↓[[ | !↑[[Potassium|K<sup>+</sup>]], ↓[[Ca|Ca<sup>+2</sup>]], ↑[[Chloride|Cl<sup>-</sup>]] | ||
!− | |||
! | !− | ||
! | !− | ||
! | ![[Bartter syndrome laboratory findings|Laboratory findings]] | ||
![[ | ![[Growth retardation]], [[tetany]], [[muscle cramp]] | ||
|- | |- | ||
![[ | ! style="background: #DCDCDC; text-align: center;" |[[Liddle syndrome]]<ref name="pmid29534496">{{cite journal |vauthors=Tetti M, Monticone S, Burrello J, Matarazzo P, Veglio F, Pasini B, Jeunemaitre X, Mulatero P |title=Liddle Syndrome: Review of the Literature and Description of a New Case |journal=Int J Mol Sci |volume=19 |issue=3 |pages= |date=March 2018 |pmid=29534496 |pmc=5877673 |doi=10.3390/ijms19030812 |url=}}</ref> | ||
! | !− | ||
! | !− | ||
!+/ | ! +/− | ||
! | !− | ||
! | !− | ||
!↑ | !↑ | ||
! | !− | ||
!+ | ! +/− | ||
![[Metabolic alkalosis]] | ![[Metabolic alkalosis]] | ||
![[ | !↑[[Potassium|K<sup>+</sup>]], ↓'''[[Sodium|Na<sup>+</sup>]]''' | ||
!↓'''[[Plasma renin activity|PRA]]''', ↓'''[[Aldosterone|PAC]]''' | |||
! | !− | ||
!− | |||
![[Bartter syndrome laboratory findings|Laboratory findings]] | |||
! | ![[Pseudohyperaldosteronism]] | ||
|- | |- | ||
! rowspan="5" |[[Gastrointestinal disorders]] | ! rowspan="5" style="background: #DCDCDC; text-align: center;" |[[Gastrointestinal disorders]] | ||
![[Gastrointestinal bleeding|GI bleeding]]<ref name="pmid22901631">{{cite journal| author=Asmar A, Mohandas R, Wingo CS| title=A physiologic-based approach to the treatment of a patient with hypokalemia. | journal=Am J Kidney Dis | year= 2012 | volume= 60 | issue= 3 | pages= 492-7 | pmid=22901631 | doi=10.1053/j.ajkd.2012.01.031 | pmc=4776048 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22901631 }}</ref> | ! style="background: #DCDCDC; text-align: center;" |[[Gastrointestinal bleeding|GI bleeding]]<ref name="pmid22901631">{{cite journal| author=Asmar A, Mohandas R, Wingo CS| title=A physiologic-based approach to the treatment of a patient with hypokalemia. | journal=Am J Kidney Dis | year= 2012 | volume= 60 | issue= 3 | pages= 492-7 | pmid=22901631 | doi=10.1053/j.ajkd.2012.01.031 | pmc=4776048 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22901631 }}</ref> | ||
!+ | ! + | ||
! | !− | ||
! | !− | ||
!+ | ! + | ||
! | !− | ||
!↓ | !↓ | ||
! | !− | ||
! | !− | ||
!Normal | !Normal | ||
!Normal | !Normal | ||
! rowspan="16" |< 3 | |||
! rowspan="16" |< 20 mEq/g | |||
![[Anemia]] | ![[Anemia]] | ||
! | !− | ||
! | !− | ||
! | ![[Bartter syndrome laboratory findings|Laboratory findings]] | ||
![[Orthostatic hypotension]], [[ | ![[Orthostatic hypotension]], [[bradycardia]] | ||
|- | |- | ||
![[Vomiting]]<ref name="pmid22169581">{{cite journal |vauthors=Cheungpasitporn W, Suksaranjit P, Chanprasert S |title=Pathophysiology of vomiting-induced hypokalemia and diagnostic approach |journal=Am J Emerg Med |volume=30 |issue=2 |pages=384 |date=February 2012 |pmid=22169581 |doi=10.1016/j.ajem.2011.10.005 |url=}}</ref> | ! style="background: #DCDCDC; text-align: center;" |[[Vomiting]]<ref name="pmid22169581">{{cite journal |vauthors=Cheungpasitporn W, Suksaranjit P, Chanprasert S |title=Pathophysiology of vomiting-induced hypokalemia and diagnostic approach |journal=Am J Emerg Med |volume=30 |issue=2 |pages=384 |date=February 2012 |pmid=22169581 |doi=10.1016/j.ajem.2011.10.005 |url=}}</ref> | ||
!+ | ! + | ||
! | !− | ||
! | !− | ||
!+ | ! + | ||
! | !− | ||
!↓ | !↓ | ||
! | !− | ||
! | !− | ||
![[Metabolic alkalosis]] | ![[Metabolic alkalosis]] | ||
![[Chloride|Cl]] <20 mEq/L | ![[Chloride|Cl<sup>-</sup>]] <20 mEq/L | ||
! | !− | ||
! | !− | ||
! | !− | ||
! | ![[Bartter syndrome laboratory findings|Laboratory findings]] | ||
!Dry [[mucous membranes]], [[ | !Dry [[mucous membranes]], [[lethargy]] | ||
|- | |- | ||
!Severe [[diarrhea]]<ref name="pmid28580600">{{cite journal |vauthors=Bazerbachi F, Haffar S, Szarka LA, Wang Z, Prokop LJ, Murad MH, Camilleri M |title=Secretory diarrhea and hypokalemia associated with colonic pseudo-obstruction: A case study and systematic analysis of the literature |journal=Neurogastroenterol. Motil. |volume=29 |issue=11 |pages= |date=November 2017 |pmid=28580600 |doi=10.1111/nmo.13120 |url=}}</ref> | ! style="background: #DCDCDC; text-align: center;" |Severe [[diarrhea]]<ref name="pmid28580600">{{cite journal |vauthors=Bazerbachi F, Haffar S, Szarka LA, Wang Z, Prokop LJ, Murad MH, Camilleri M |title=Secretory diarrhea and hypokalemia associated with colonic pseudo-obstruction: A case study and systematic analysis of the literature |journal=Neurogastroenterol. Motil. |volume=29 |issue=11 |pages= |date=November 2017 |pmid=28580600 |doi=10.1111/nmo.13120 |url=}}</ref> | ||
!+ | ! + | ||
! | !− | ||
! | !− | ||
!+ | ! + | ||
! | !− | ||
!↓ | !↓ | ||
! | !− | ||
! | !− | ||
![[Metabolic alkalosis]] | ![[Metabolic alkalosis]] | ||
![[Potassium|K]]<20 mEq/L | ![[Potassium|K<sup>+</sup>]]<20 mEq/L | ||
! | !− | ||
! | !− | ||
! | !− | ||
! | ![[Bartter syndrome laboratory findings|Laboratory findings]] | ||
!Dry [[mucous membranes]], [[ | !Dry [[mucous membranes]], [[lethargy]] | ||
|- | |- | ||
![[Villous adenoma]]<ref name="pmid24199207">{{cite journal| author=Sanchez Garcia S, Villarejo Campos P, Manzanares Campillo Mdel C, Gil Rendo A, Muñoz Atienza V, García Santos EP et al.| title=Hypersecretory villous adenoma as the primary cause of an intestinal intussusception and McKittrick-Wheelock syndrome. | journal=Can J Gastroenterol | year= 2013 | volume= 27 | issue= 11 | pages= 621-2 | pmid=24199207 | doi= | pmc=3816940 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24199207 }}</ref> | ! style="background: #DCDCDC; text-align: center;" |[[Villous adenoma]]<ref name="pmid24199207">{{cite journal| author=Sanchez Garcia S, Villarejo Campos P, Manzanares Campillo Mdel C, Gil Rendo A, Muñoz Atienza V, García Santos EP et al.| title=Hypersecretory villous adenoma as the primary cause of an intestinal intussusception and McKittrick-Wheelock syndrome. | journal=Can J Gastroenterol | year= 2013 | volume= 27 | issue= 11 | pages= 621-2 | pmid=24199207 | doi= | pmc=3816940 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24199207 }}</ref> | ||
!+ | ! + | ||
! | !− | ||
! | !− | ||
!+ | ! + | ||
! | !− | ||
!↓ | !↓ | ||
! | !− | ||
! | !− | ||
!Normal | !Normal | ||
![[Potassium|K]] and [[Chloride|Cl]] <20 mEq/L | ![[Potassium|K<sup>+</sup>]] and [[Chloride|Cl<sup>-</sup>]] <20 mEq/L | ||
![[Anemia]] | ![[Anemia]] | ||
! | !− | ||
! | !− | ||
![[Colonoscopy]] | ![[Colonoscopy]] | ||
![[Hematochezia]] | ![[Hematochezia]] | ||
|- | |- | ||
![[VIPoma]]<ref name="pmid3035922">{{cite journal |vauthors=Krejs GJ |title=VIPoma syndrome |journal=Am. J. Med. |volume=82 |issue=5B |pages=37–48 |date=May 1987 |pmid=3035922 |doi= |url=}}</ref> | ! style="background: #DCDCDC; text-align: center;" |[[VIPoma]]<ref name="pmid3035922">{{cite journal |vauthors=Krejs GJ |title=VIPoma syndrome |journal=Am. J. Med. |volume=82 |issue=5B |pages=37–48 |date=May 1987 |pmid=3035922 |doi= |url=}}</ref> | ||
!+ | ! + | ||
!+/ | ! +/− | ||
! | !− | ||
!+ | ! + | ||
! | !− | ||
!↓ | !↓ | ||
![[Facial flushing]], [[ | ![[Facial flushing]], [[skin rash]] | ||
!+ | ! + | ||
!Normal | !Normal | ||
![[Potassium|K]]<20 mEq/L | ![[Potassium|K<sup>+</sup>]]<20 mEq/L | ||
!'''[[Osmolarity|Stool osmolar gap]] '''<50 mOsm/kg | !'''[[Osmolarity|Stool osmolar gap]] '''<50 mOsm/kg | ||
!'''[[Endoscopic ultrasound]] for''' [[VIPoma|VIPomas]] of | !'''[[Endoscopic ultrasound]] for''' [[VIPoma|VIPomas]] of 2−3 mm | ||
![[Pancreatic]] [[VIPoma|VIPomas]] >3 cm | ![[Pancreatic]] [[VIPoma|VIPomas]] >3 cm | ||
!Laboratory findings | ![[Bartter syndrome laboratory findings|Laboratory findings]] | ||
![[Weight loss]] | ![[Weight loss]] | ||
|- | |- | ||
! rowspan="5" |[[Neuropsychiatric|Neuropsychiatric disorders]] | ! rowspan="5" style="background: #DCDCDC; text-align: center;" |[[Neuropsychiatric|Neuropsychiatric disorders]] | ||
![[ | ! style="background: #DCDCDC; text-align: center;" |[[Polydipsia|Primary polydipsia]]<ref name="pmid25688318">{{cite journal| author=Gill M, McCauley M| title=Psychogenic polydipsia: the result, or cause of, deteriorating psychotic symptoms? A case report of the consequences of water intoxication. | journal=Case Rep Psychiatry | year= 2015 | volume= 2015 | issue= | pages= 846459 | pmid=25688318 | doi=10.1155/2015/846459 | pmc=4320790 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25688318 }}</ref> | ||
! | !− | ||
! | !− | ||
! | ! + | ||
! | !− | ||
!+ | ! + | ||
!Normal | !Normal | ||
! | !− | ||
!+/ | ! +/− | ||
! | !Normal | ||
![[ | !↓[[Osmolarity|Urine osmolarity]] | ||
! | !↓'''[[Sodium|Na<sup>+</sup>]]''' | ||
! | !− | ||
! | !− | ||
! | !'''Water restriction test''' | ||
![[ | ![[Psychosis]] | ||
|- | |- | ||
![[Central diabetes insipidus]]<ref name="pmid24707338">{{cite journal| author=Nguyen FN, Kar JK, Verduzco-Gutierrez M, Zakaria A| title=A case of hypokalemic paralysis in a patient with neurogenic diabetes insipidus. | journal=Neurohospitalist | year= 2014 | volume= 4 | issue= 2 | pages= 90-3 | pmid=24707338 | doi=10.1177/1941874413495702 | pmc=3975788 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24707338 }}</ref> | ! style="background: #DCDCDC; text-align: center;" |[[Central diabetes insipidus]]<ref name="pmid24707338">{{cite journal| author=Nguyen FN, Kar JK, Verduzco-Gutierrez M, Zakaria A| title=A case of hypokalemic paralysis in a patient with neurogenic diabetes insipidus. | journal=Neurohospitalist | year= 2014 | volume= 4 | issue= 2 | pages= 90-3 | pmid=24707338 | doi=10.1177/1941874413495702 | pmc=3975788 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24707338 }}</ref> | ||
!+ | ! + | ||
! | !− | ||
!+ | ! + | ||
! | !− | ||
!+ | ! + | ||
!Normal or ↓ | !Normal or ↓ | ||
! | !− | ||
! | !− | ||
!Normal | !Normal | ||
!↓[[Osmolarity|Urine osmolarity]] | !↓[[Osmolarity|Urine osmolarity]] | ||
!↑[[Sodium|Na]] | !↑'''[[Sodium|Na<sup>+</sup>]]''' | ||
! | !− | ||
! | !− | ||
!'''Water restriction test''' | !'''Water restriction test''' | ||
![[Encephalopathy|Ischemic encephalopathy]] | ![[Encephalopathy|Ischemic encephalopathy]] | ||
|- | |- | ||
![[Bulimia nervosa]]<ref name="pmid15213788">{{cite journal| author=Rushing JM, Jones LE, Carney CP| title=Bulimia Nervosa: A Primary Care Review. | journal=Prim Care Companion J Clin Psychiatry | year= 2003 | volume= 5 | issue= 5 | pages= 217-224 | pmid=15213788 | doi= | pmc=419300 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15213788 }}</ref> | ! style="background: #DCDCDC; text-align: center;" |[[Bulimia nervosa]]<ref name="pmid15213788">{{cite journal| author=Rushing JM, Jones LE, Carney CP| title=Bulimia Nervosa: A Primary Care Review. | journal=Prim Care Companion J Clin Psychiatry | year= 2003 | volume= 5 | issue= 5 | pages= 217-224 | pmid=15213788 | doi= | pmc=419300 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15213788 }}</ref> | ||
! | !− | ||
! | !− | ||
! | !− | ||
!+/ | ! +/− | ||
! | !− | ||
!Normal or ↓ | !Normal or ↓ | ||
![[Asteatotic Dermatitis|Asteatotic '''skin''']] '''[[Carotenodermia|C]]'''[[Carotenodermia|arotenodermia]] | ![[Asteatotic Dermatitis|Asteatotic '''skin''']] '''[[Carotenodermia|C]]'''[[Carotenodermia|arotenodermia]] | ||
! | !− | ||
!Normal | !Normal | ||
!↑[[Potassium|K]], ↓[[Chloride|Cl]] | !↑[[Potassium|K<sup>+</sup>]], ↓[[Chloride|Cl<sup>-</sup>]] | ||
! | !− | ||
! | !− | ||
! | !− | ||
![[Psychological analysis|Psychological interview]] | ![[Psychological analysis|Psychological interview]] | ||
! [[Parotid gland]] enlargement, [[ | ! [[Parotid gland]] enlargement, [[lanugo]]−like hair | ||
|- | |- | ||
![[Anorexia nervosa]]<ref name="pmid21670105">{{cite journal| author=Liang CC, Yeh HC| title=Hypokalemic nephropathy in anorexia nervosa. | journal=CMAJ | year= 2011 | volume= 183 | issue= 11 | pages= E761 | pmid=21670105 | doi=10.1503/cmaj.101790 | pmc=3153553 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21670105 }}</ref> | ! style="background: #DCDCDC; text-align: center;" |[[Anorexia nervosa]]<ref name="pmid21670105">{{cite journal| author=Liang CC, Yeh HC| title=Hypokalemic nephropathy in anorexia nervosa. | journal=CMAJ | year= 2011 | volume= 183 | issue= 11 | pages= E761 | pmid=21670105 | doi=10.1503/cmaj.101790 | pmc=3153553 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21670105 }}</ref> | ||
!+ | ! + | ||
! | !− | ||
! | !− | ||
!+/ | ! +/− | ||
! | !− | ||
!↓ | !↓ | ||
![[Xerosis]], [[Telogen effluvium| | ![[Xerosis]], [[Telogen effluvium|hair effluvium]] | ||
! | !− | ||
!Normal | !Normal | ||
!↑[[Potassium|K]], ↓[[Chloride|Cl]] | !↑[[Potassium|K<sup>+</sup>]], ↓[[Chloride|Cl<sup>-</sup>]] | ||
! | !− | ||
! | !− | ||
! | !− | ||
![[Psychological analysis|Psychological interview]] | ![[Psychological analysis|Psychological interview]] | ||
![[Orthostatic hypotension]], [[ | ![[Orthostatic hypotension]], [[bradycardia]] | ||
|- | |- | ||
![[ | ! style="background: #DCDCDC; text-align: center;" |[[Hypokalemic periodic paralysis]]<ref name="urlHypokalemic periodic paralysis | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program">{{cite web |url=https://rarediseases.info.nih.gov/diseases/6729/hypokalemic-periodic-paralysis |title=Hypokalemic periodic paralysis | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program |format= |work= |accessdate=}}</ref> | ||
! | ! + | ||
! | !− | ||
! | !− | ||
! | !− | ||
!+ | ! +/− | ||
!Normal | !Normal or ↓ | ||
! | !− | ||
!+/ | ! +/− | ||
! | ![[Metabolic alkalosis]] | ||
! | ![[Potassium|K<sup>+</sup>]]<20 mEq/L | ||
!↓[[ | ![[Thyrotoxicosis]], ↓[[Magnesium|Mg<sup>+</sup>]], ↓PO<sub>4</sub><sup>-3</sup> | ||
! | !− | ||
! | !− | ||
! | ![[Bartter syndrome laboratory findings|Laboratory findings]] | ||
![[ | ![[Paralysis|Paralytic episodes]], [[arrhythmias]] | ||
|- | |- | ||
! rowspan="6" |[[Systemic diseases]] | ! rowspan="6" style="background: #DCDCDC; text-align: center;" |[[Systemic diseases]] | ||
![[Hypothermia]]<ref name="pmid9795553">{{cite journal |vauthors=Zydlewski AW, Hasbargen JA |title=Hypothermia-induced hypokalemia |journal=Mil Med |volume=163 |issue=10 |pages=719–21 |date=October 1998 |pmid=9795553 |doi= |url=}}</ref> | ! style="background: #DCDCDC; text-align: center;" |[[Hypothermia]]<ref name="pmid9795553">{{cite journal |vauthors=Zydlewski AW, Hasbargen JA |title=Hypothermia-induced hypokalemia |journal=Mil Med |volume=163 |issue=10 |pages=719–21 |date=October 1998 |pmid=9795553 |doi= |url=}}</ref> | ||
! | !− | ||
! | !− | ||
! | !− | ||
!+/ | ! +/− | ||
! | !− | ||
!Normal | !Normal | ||
![[Frostbite]] | ![[Frostbite]] | ||
! | !− | ||
!Normal | !Normal | ||
!Normal | !Normal | ||
! | !− | ||
! | !− | ||
! | !− | ||
!Clinical findings | !Clinical findings | ||
![[Loss of consciousness|Impaired mental state]] | ![[Loss of consciousness|Impaired mental state]] | ||
|- | |- | ||
![[Alcoholism]]<ref name="pmid12189007">{{cite journal |vauthors=Elisaf M, Liberopoulos E, Bairaktari E, Siamopoulos K |title=Hypokalaemia in alcoholic patients |journal=Drug Alcohol Rev |volume=21 |issue=1 |pages=73–6 |date=March 2002 |pmid=12189007 |doi=10.1080/09595230220119282 |url=}}</ref> | ! style="background: #DCDCDC; text-align: center;" |[[Alcoholism]]<ref name="pmid12189007">{{cite journal |vauthors=Elisaf M, Liberopoulos E, Bairaktari E, Siamopoulos K |title=Hypokalaemia in alcoholic patients |journal=Drug Alcohol Rev |volume=21 |issue=1 |pages=73–6 |date=March 2002 |pmid=12189007 |doi=10.1080/09595230220119282 |url=}}</ref> | ||
!+ | ! + | ||
!+/ | ! +/− | ||
!+ | ! + | ||
! | !− | ||
!+ | ! + | ||
!Normal or ↓ | !Normal or ↓ | ||
![[Icterus]], [[ | ![[Icterus]], [[caput medusae]] | ||
!+ | ! + | ||
![[Metabolic alkalosis]] | ![[Metabolic alkalosis]] | ||
![[Ketonuria]] | ![[Ketonuria]] | ||
![[Anemia]] | ![[Anemia]] | ||
! | !− | ||
! | !− | ||
!Clinical findings | !Clinical findings | ||
![[Digital clubbing]], [[ | ![[Digital clubbing]], [[gynecomastia]] | ||
|- | |- | ||
![[Diabetic ketoacidosis]]<ref name="pmid25430801">{{cite journal| author=Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM| title=Profound hypokalemia associated with severe diabetic ketoacidosis. | journal=Pediatr Diabetes | year= 2016 | volume= 17 | issue= 1 | pages= 61-5 | pmid=25430801 | doi=10.1111/pedi.12246 | pmc=4896141 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25430801 }}</ref> | ! style="background: #DCDCDC; text-align: center;" |[[Diabetic ketoacidosis]]<ref name="pmid25430801">{{cite journal| author=Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM| title=Profound hypokalemia associated with severe diabetic ketoacidosis. | journal=Pediatr Diabetes | year= 2016 | volume= 17 | issue= 1 | pages= 61-5 | pmid=25430801 | doi=10.1111/pedi.12246 | pmc=4896141 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25430801 }}</ref> | ||
!+ | ! + | ||
!+/ | ! +/− | ||
!+ | ! + | ||
! | !− | ||
!+ | ! + | ||
!↓ | !↓ | ||
![[Xerosis]] | ![[Xerosis]] | ||
! | !− | ||
![[Metabolic acidosis]] | ![[Metabolic acidosis]] | ||
![[Ketonuria]] | ![[Ketonuria]] | ||
!↑Serum [[ketone]], ↑[[ | !↑Serum [[ketone]], ↑ [[blood glucose]] | ||
! | !− | ||
! | !− | ||
!Laboratory findings | ![[Bartter syndrome laboratory findings|Laboratory findings]] | ||
!Dry [[mucous membranes]], [[ | !Dry [[mucous membranes]], [[shock]] | ||
|- | |- | ||
![[Hypomagnesemia]]<ref name="pmid17804670">{{cite journal |vauthors=Huang CL, Kuo E |title=Mechanism of hypokalemia in magnesium deficiency |journal=J. Am. Soc. Nephrol. |volume=18 |issue=10 |pages=2649–52 |date=October 2007 |pmid=17804670 |doi=10.1681/ASN.2007070792 |url=}}</ref> | ! style="background: #DCDCDC; text-align: center;" |[[Hypomagnesemia]]<ref name="pmid17804670">{{cite journal |vauthors=Huang CL, Kuo E |title=Mechanism of hypokalemia in magnesium deficiency |journal=J. Am. Soc. Nephrol. |volume=18 |issue=10 |pages=2649–52 |date=October 2007 |pmid=17804670 |doi=10.1681/ASN.2007070792 |url=}}</ref> | ||
!+ | ! + | ||
! | !− | ||
! | !− | ||
!+/ | ! +/− | ||
! | !− | ||
!Normal | !Normal | ||
! | !− | ||
!+/ | ! +/− | ||
![[Metabolic alkalosis]] | ![[Metabolic alkalosis]] | ||
! | !− | ||
!↓[[Calcium|Ca]] | !↓[[Calcium|Ca<sup>+2</sup>]] | ||
! | !− | ||
! | !− | ||
!Laboratory findings | ![[Bartter syndrome laboratory findings|Laboratory findings]] | ||
![[Trousseau's sign|Trousseau]] and [[Chvostek's Sign|Chvostek signs]] | ![[Trousseau's sign|Trousseau]] and [[Chvostek's Sign|Chvostek signs]] | ||
|- | |- | ||
![[Burns]]<ref name="pmid27183443">{{cite journal| author=Nielson CB, Duethman NC, Howard JM, Moncure M, Wood JG| title=Burns: Pathophysiology of Systemic Complications and Current Management. | journal=J Burn Care Res | year= 2017 | volume= 38 | issue= 1 | pages= e469-e481 | pmid=27183443 | doi=10.1097/BCR.0000000000000355 | pmc=5214064 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27183443 }}</ref> | ! style="background: #DCDCDC; text-align: center;" |[[Burns]]<ref name="pmid27183443">{{cite journal| author=Nielson CB, Duethman NC, Howard JM, Moncure M, Wood JG| title=Burns: Pathophysiology of Systemic Complications and Current Management. | journal=J Burn Care Res | year= 2017 | volume= 38 | issue= 1 | pages= e469-e481 | pmid=27183443 | doi=10.1097/BCR.0000000000000355 | pmc=5214064 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27183443 }}</ref> | ||
!+/ | ! +/− | ||
! | !− | ||
! | !− | ||
!+ | ! + | ||
! | !− | ||
!↓ | !↓ | ||
![[Vesicle]] and bullae, [[ | ![[Vesicle]] and bullae, [[erythema]] | ||
!+ | ! + | ||
!Normal | !Normal | ||
! | !− | ||
![[Acute phase reactant]] | ![[Acute phase reactant]] | ||
! | !− | ||
! | !− | ||
!Clinical findings | !Clinical findings | ||
![[Dehydration]] | ![[Dehydration]] | ||
|- | |- | ||
![[Cystic fibrosis]]<ref name="pmid9048354">{{cite journal |vauthors=Bates CM, Baum M, Quigley R |title=Cystic fibrosis presenting with hypokalemia and metabolic alkalosis in a previously healthy adolescent |journal=J. Am. Soc. Nephrol. |volume=8 |issue=2 |pages=352–5 |date=February 1997 |pmid=9048354 |doi= |url=}}</ref> | ! style="background: #DCDCDC; text-align: center;" |[[Cystic fibrosis]]<ref name="pmid9048354">{{cite journal |vauthors=Bates CM, Baum M, Quigley R |title=Cystic fibrosis presenting with hypokalemia and metabolic alkalosis in a previously healthy adolescent |journal=J. Am. Soc. Nephrol. |volume=8 |issue=2 |pages=352–5 |date=February 1997 |pmid=9048354 |doi= |url=}}</ref> | ||
!+/ | ! +/− | ||
!+/ | ! +/− | ||
! | !− | ||
!+/ | ! +/− | ||
! | !− | ||
!↓ | !↓ | ||
![[Aquagenic wrinkling of the palms|Early aquagenic '''skin''' wrinkling]] | ![[Aquagenic wrinkling of the palms|Early aquagenic '''skin''' wrinkling]] | ||
!+/ | ! +/− | ||
!Normal | !Normal | ||
! | !− | ||
! | !− | ||
! | ! - | ||
![[Pulmonary]] infiltration | ![[Pulmonary]] infiltration | ||
!'''[[Sweat chloride test]]''' | !'''[[Sweat chloride test]]''' | ||
![[Pancreatic insufficiency]] | ![[Pancreatic insufficiency]] | ||
|} | |} | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} |
Latest revision as of 22:47, 14 February 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
Potassium is one of the intracellular cation. Any derangement of potassium serum levels can disturb the transmembrane potential and renders excitable cells (nerve and muscle) hyperpolarized and less excitable. However, cardiac cells don't obey this rule and become hyperexcitable. Potassium regulation is essential to maintain a normal activity in cells. Any imparment in potassium serum levels will have severe consequences on several organs especially the heart and the nervous system.
Differentiating Causes of Hypokalemia
Differentiating the diseases that can cause hypokalemia is as following table:
References
- ↑ Bourke E, Delaney V (1994). "Prevention of hypokalemia caused by diuretics". Heart Dis Stroke. 3 (2): 63–7. PMID 8199766.
- ↑ Wu C, Xin J, Xin M, Zou H, Jing L, Zhu C; et al. (2016). "Hypokalemic myopathy in primary aldosteronism: A case report". Exp Ther Med. 12 (6): 4064–4066. doi:10.3892/etm.2016.3864. PMC 5228118. PMID 28101185.
- ↑ Torpy DJ, Mullen N, Ilias I, Nieman LK (September 2002). "Association of hypertension and hypokalemia with Cushing's syndrome caused by ectopic ACTH secretion: a series of 58 cases". Ann. N. Y. Acad. Sci. 970: 134–44. PMID 12381548.
- ↑ Choi HY, Ha SK (2013). "Potassium balances in maintenance hemodialysis". Electrolyte Blood Press. 11 (1): 9–16. doi:10.5049/EBP.2013.11.1.9. PMC 3741441. PMID 23946760.
- ↑ Hebert SC (September 2003). "Bartter syndrome". Curr. Opin. Nephrol. Hypertens. 12 (5): 527–32. doi:10.1097/01.mnh.0000088732.87142.43. PMID 12920401.
- ↑ Knoers NV, Levtchenko EN (2008). "Gitelman syndrome". Orphanet J Rare Dis. 3: 22. doi:10.1186/1750-1172-3-22. PMC 2518128. PMID 18667063.
- ↑ Tetti M, Monticone S, Burrello J, Matarazzo P, Veglio F, Pasini B, Jeunemaitre X, Mulatero P (March 2018). "Liddle Syndrome: Review of the Literature and Description of a New Case". Int J Mol Sci. 19 (3). doi:10.3390/ijms19030812. PMC 5877673. PMID 29534496.
- ↑ Asmar A, Mohandas R, Wingo CS (2012). "A physiologic-based approach to the treatment of a patient with hypokalemia". Am J Kidney Dis. 60 (3): 492–7. doi:10.1053/j.ajkd.2012.01.031. PMC 4776048. PMID 22901631.
- ↑ Cheungpasitporn W, Suksaranjit P, Chanprasert S (February 2012). "Pathophysiology of vomiting-induced hypokalemia and diagnostic approach". Am J Emerg Med. 30 (2): 384. doi:10.1016/j.ajem.2011.10.005. PMID 22169581.
- ↑ Bazerbachi F, Haffar S, Szarka LA, Wang Z, Prokop LJ, Murad MH, Camilleri M (November 2017). "Secretory diarrhea and hypokalemia associated with colonic pseudo-obstruction: A case study and systematic analysis of the literature". Neurogastroenterol. Motil. 29 (11). doi:10.1111/nmo.13120. PMID 28580600.
- ↑ Sanchez Garcia S, Villarejo Campos P, Manzanares Campillo Mdel C, Gil Rendo A, Muñoz Atienza V, García Santos EP; et al. (2013). "Hypersecretory villous adenoma as the primary cause of an intestinal intussusception and McKittrick-Wheelock syndrome". Can J Gastroenterol. 27 (11): 621–2. PMC 3816940. PMID 24199207.
- ↑ Krejs GJ (May 1987). "VIPoma syndrome". Am. J. Med. 82 (5B): 37–48. PMID 3035922.
- ↑ Gill M, McCauley M (2015). "Psychogenic polydipsia: the result, or cause of, deteriorating psychotic symptoms? A case report of the consequences of water intoxication". Case Rep Psychiatry. 2015: 846459. doi:10.1155/2015/846459. PMC 4320790. PMID 25688318.
- ↑ Nguyen FN, Kar JK, Verduzco-Gutierrez M, Zakaria A (2014). "A case of hypokalemic paralysis in a patient with neurogenic diabetes insipidus". Neurohospitalist. 4 (2): 90–3. doi:10.1177/1941874413495702. PMC 3975788. PMID 24707338.
- ↑ Rushing JM, Jones LE, Carney CP (2003). "Bulimia Nervosa: A Primary Care Review". Prim Care Companion J Clin Psychiatry. 5 (5): 217–224. PMC 419300. PMID 15213788.
- ↑ Liang CC, Yeh HC (2011). "Hypokalemic nephropathy in anorexia nervosa". CMAJ. 183 (11): E761. doi:10.1503/cmaj.101790. PMC 3153553. PMID 21670105.
- ↑ "Hypokalemic periodic paralysis | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program".
- ↑ Zydlewski AW, Hasbargen JA (October 1998). "Hypothermia-induced hypokalemia". Mil Med. 163 (10): 719–21. PMID 9795553.
- ↑ Elisaf M, Liberopoulos E, Bairaktari E, Siamopoulos K (March 2002). "Hypokalaemia in alcoholic patients". Drug Alcohol Rev. 21 (1): 73–6. doi:10.1080/09595230220119282. PMID 12189007.
- ↑ Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM (2016). "Profound hypokalemia associated with severe diabetic ketoacidosis". Pediatr Diabetes. 17 (1): 61–5. doi:10.1111/pedi.12246. PMC 4896141. PMID 25430801.
- ↑ Huang CL, Kuo E (October 2007). "Mechanism of hypokalemia in magnesium deficiency". J. Am. Soc. Nephrol. 18 (10): 2649–52. doi:10.1681/ASN.2007070792. PMID 17804670.
- ↑ Nielson CB, Duethman NC, Howard JM, Moncure M, Wood JG (2017). "Burns: Pathophysiology of Systemic Complications and Current Management". J Burn Care Res. 38 (1): e469–e481. doi:10.1097/BCR.0000000000000355. PMC 5214064. PMID 27183443.
- ↑ Bates CM, Baum M, Quigley R (February 1997). "Cystic fibrosis presenting with hypokalemia and metabolic alkalosis in a previously healthy adolescent". J. Am. Soc. Nephrol. 8 (2): 352–5. PMID 9048354.